人類乳突病毒感染與腎移植術後上泌尿道尿路上皮癌提早發生相關
林士勛1、羅浩倫1、鄭元佐1、陳彥達1、江博暉1、黃純真2，黃冠霖1、劉惠瑛1
高雄長庚紀念醫院外科部泌尿科1 高雄長庚紀念醫院病理科2
Human Polyomavirus Is Associated with Earlier Onset of Upper Urinary Tract Urothelial Carcinoma in Patients after Kidney transplantation
Shih-Hsun Lin 1、 Hao-Lun Luo 1、 Yuan-Tso Cheng 1、 Yen-Ta Chen 1、 Po-Huang Chiang 1
, Zhun-Zhen Huang 2、 Guan-Lin Huang 1、Hui-Ying Liu 1
Department of Urology, Chang Gung Memorial Hospital, Kaohsiung Taiwan1
Department of Pathology, Chang Gung Memorial Hospital, Kaohsiung Taiwan2
Purpose: Polyomavirus have been reported to be oncogenic due to viral integration into the human genome. Relatively high prevalence of upper urinary tract urothelial carcinoma (UT-UC) was noted after kidney transplantation in Taiwan. However, little was known about the impact of polyomavirus on the urothelial cancer behavior. Therefore, the aim of this study is to analyze the characteristics of polyomavirus related UT-UC after kidney transplantation.
Material and methods: From 2005 to 2014, 27 patients were found to have UT-UCs after kidney transplantation. All the patients underwent standard nephroureterectomy. Detailed perioperative parameters were obtained from chart record. Qualified pathologist who is blinded to the clinical outcome examined large T antigen expression and pathological features. All the patients were divided according to the positive expression of large T antigen or not. Patients were followed up via regular cystoscopy, contralateral renal ultrasonography, and annual CT scan to detect any post-operative disease recurrence. The software SPSS version 17 was used for statistical analysis. A p<0.05 was considered statistically significant.
Results: In the patient demography, significantly younger age was found in patients with large T antigen positive UT-UCs compared with negative control group(48.1±8.3 years vs 54.6± 4.1 years, p=0.013). Regarding to the pathological features and oncologic outcome, there was no obvious differences between these two groups. Organ confined status is the only prognostic factors associated with systemic disease recurrence (p=0.017).
Conclusions: Though UT-UC commonly develops in elderly, earlier onset of post kidney transplantation UT-UCs was observed especially in patients with positive large T antigen expression in our cohort. This preliminary result provides valuable experience suggesting more frequent upper urinary tract screening for polyomavirus infected patients after kidney transplantation in Taiwan.